Baby and child eczema - Mumsnet users' questions answered

Baby with eczema

Baby and childhood eczema causes distress to both children and parents. Coping with flare ups or angry, irritated skin, disrupts sleep patterns and can be very upsetting for all involved. Shedding some light into this complex condition is Dr Catherine Borysiewicz, an experienced consultant dermatologist within the NHS.

La Roche-Posay asked Mumsnet users to share their top questions to help cope with this condition. From how often to bathe a child with eczema to the possible causes, read Dr Catherine’s advice on the best ways to care for your child's delicate skin.

What is eczema and how to keep it under control?

Is eczema often linked to diet? Which foods are worth excluding to try to clear it up?

Girl eats vegetables

There is a lot of conflicting information about the importance of diet and the link between eczema and food allergies. Eczema can be more commonly associated with food allergies, hay fever and asthma, but the reasons why this happens are not 100% understood. Current evidence suggests that the first problem lies with an altered skin barrier – this is the ability of your skin to defend itself from allergens, irritants and infections present in our environment. It is suggested that if your child is exposed to irritants and allergens through inflamed skin, rather than in an appropriate way, the immune system can become incorrectly activated resulting in allergies.

So the best thing is to support your child’s skin barrier with regular moisturising and treating any patches of active eczema with GP prescribed treatments such as mild steroid creams. The skin requires a balanced diet to remain healthy so ensure that your child has a mix of fruit, vegetables and enough protein. Fish oils are also very beneficial – oily fish like salmon helps too.

If your child has eczema as a baby, is it something that they can “grow out of” as they get older?

Eczema usually presents from four months to two years of age. After that it tends to gradually improve – 60% of cases settle by ten years old – and further improve during teenage years when oil production in the skin is boosted, helping to counteract some of the dryness associated with eczema-prone skin.

My daughter's eczema seems to get worse when she is ill. Why is this and what is the best strategy for managing it?

Girl rests on mothers lap Illness is certainly a common cause of eczema flares. This can be through skin infections, but also unrelated viral illnesses that are incredibly common during childhood. Have a treatment plan for when things start to flare – avoid soaps, increase the number of times you are applying a moisturiser and treat any active patches as directed by your GP. Try to recognise flares quickly, as this will allow you to be as proactive as possible in getting on top of it.

How often should you bathe a child with eczema?

Dermatologists recommend a daily bath for all children and adults suffering from eczema. This is to reduce the buildup of Staphylococcus aureus bacteria on the skin and prevent infected eczema flares. Try to keep the baths short (15 minutes maximum) and ensure the water is not too hot. Use a soap substitute such as LIPIKAR Syndet AP+ which will not strip important natural oils from your child’s skin. If you find it helpful, add a bath emollient to the water.

We love to go swimming as a family but this causes an eczema flare-up on my baby. What would you suggest for this?

The chlorine in pool water will dry the skin, but provided your child’s eczema is not infected, it is really nice to let your child enjoy swimming with the family. Before going into the pool, moisturise your child’s skin well – this will go some way to act as a barrier on the skin. Keep time in the pool limited. After swimming, use a soap substitute in the shower to rinse the skin well. After towel drying, put a nice thick layer of moisturiser on. We found this to be very helpful with my son. Good luck and I hope you get to continue enjoying swimming!

 Family go swimming

What makes this skincare range different from the many other skincare options for children?

The LIPIKAR AP+ range not only helps lock moisture into your child’s dry skin, it also has ingredients that help soothe the skin and reduce itchiness. It has a high concentration of glycerine and shea butter to help restore the skin’s natural barrier, and niacinamide to help prevent itchy skin and irritations. The formula also contains Aqua Posae Filiformis, which helps rebalance the bacteria on the skin surface to reduce the frequency of flare-ups. The LIPIKAR Stick is a favourite in my household, as it can be easily applied by children to reduce itchiness without scratching. My son takes it in his school bag every day.

Any tips on how to stop children scratching and do you have anything to help with the itch?

Child scratches arm Eczema is incredibly itchy so it is a normal reaction for your child to scratch a lot. The problem is that the scratching will further damage the skin, and can also form a habit in your child. Dry skin is itchy, so keep skin soothed with regular moisturiser – you can never apply too much. Treat eczema flares as guided by your GP or dermatologist with treatment creams such as steroids as these reduce inflammation in the skin and help with the itching. Some children benefit from the use of antihistamine and again this can be guided by your healthcare professional. Keep itchy skin covered with long sleeves and trousers in breathable fabrics such as cotton or linen. Younger children can also have mitts (often built into baby sleeping bags) to cover their hands. As your child gets older, try giving them soothing cool sprays or moisturising sticks such as LIPIKAR Stick AP+ to give them something to apply instead of itching. Also, remember to always keep their nails as short as possible.

GPs can be reluctant to prescribe steroids for children, but they can sometimes be the only solution to a flare up. What are your views on this?

When eczema flares occur, steroid creams form a really important part of treatment. There is often a lot of anxiety from parents and GPs about the dangers of overusing steroids and the long-term consequences of this on the skin. I want to reassure you that dermatologists will follow a ‘treatment ladder’ approach when deciding which strength steroid to recommend for eczema flares and will also give clear recommendations about how long it is safe to apply them for, as well as where they are safe to use. For example, the skin on the face and neck is thinner and more vulnerable to steroid side-effects, so a weaker steroid will be recommended for these areas.

GP talks to child

The key is to prescribe the weakest strength steroid that is effective in treating the flare. Remember that as a parent of a child with eczema, you are the expert in understanding your child’s skin and its response to treatments. It is important that you feedback to your GP or dermatologist about the frequency of flares, the number of days you are needing to use steroid creams, and roughly how long a tube of steroid cream will last. Treatments can then be stepped up or down as needed. There are also newer treatment strategies available that do not involve steroids – these products are called topical immunomodulators, and will often be considered if you are needing to frequently apply strong steroid creams.

We have tried different sun creams for my daughter but most give her a rash or itching. What sun products are best for eczema skin?

girl sits in sun Sun creams can be very challenging in anyone with eczema as the skin is sensitive and easily irritated, but it is very important not to expose your child’s skin to UV. I recommend looking for mineral sunblocks – these contain molecules that act like a mirror to reflect away UV rays, and they also don't contain chemicals, which means they are less likely to affect sensitive skin. The downside is that they often have a white tint, but I have always found this helpful to show me the areas I have missed when applying sunblock on my kids! Also, clothes with built-in factor 50 UV protection can be really useful. Keep kids covered in these garments and make sure they have high necks, long sleeves and long legs. Hats with a built-in ‘neck covering flap’ are also excellent.

Why does sunlight seem to make such a difference to my son's skin? His eczema pretty much disappears in summer only to return every autumn as soon as he's not spending hours in the sun every day.

Boys on the grass Sunlight has UVA and UVB rays. We know that exposure to both UVA and UVB can increase the risk of damage in the skin cells DNA and a long-term accumulation of such damage increases the risk of skin cancer. Your skin is constantly being internally monitored by the cells of your immune system – they're mopping up and removing damaged cells. After exposure to UVA and UVB, your skin internally reduces this immune surveillance – and without this, exposure to sunlight can create an angry, itchy or blistering reaction in everyone. However in eczema, this reduction in skin immune activity can actually help to temporarily reduce eczema activity. As dermatologists, we sometimes use this approach in eczema and prescribe a medically controlled form of UV exposure called phototherapy.

My son's eczema gets much worse when he's very tired or stressed – SATs time at school is a prime example. How can I minimise the impact of stress on his eczema?

As a dermatologist, I frequently see the impact of stress on all inflammatory skin conditions – whether it is eczema, psoriasis or acne. Stress increases the body’s production of cortisol and this can aggravate all forms of inflammation in the skin. Stress will also affect your sleep patterns, which can also affect the balance of your skin. Children are under a huge amount of pressure, and exams create a perfect storm for flares in eczema.

Explaining why the skin flares to your child will increase understanding and proactive treatment, and getting them to apply more moisturisers during times of increased stress will help support a vulnerable skin barrier. Try to keep a balance of activities during this time – give your child time to enjoy other hobbies which they find relaxing. This can also have a big impact on skin health and wellbeing. Ensure a healthy and varied diet to provide the skin with all the important ‘building blocks’ it needs – including minerals, vitamins and proteins in their meals.

Students take exam

For more information about eczema in babies and children visit the NHS website.

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